Top Things to Know: ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients with Coronary Artery Disease
- Based on information in the 2016 Heart and Stroke Statistical Update about 15.5 million Americans over the age of 20 years have Coronary Heart Disease.
- The recommendations within this Guideline supersedes recommendations in 6 published guidelines:
- 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery
- 2014 ACC/AHA Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes
- 2011 ACCF/AHA Guideline for Percutaneous Coronary Intervention
- 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Non-cardiac Surgery
- 2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease
- 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction
- DAPT (dual antiplatelet therapy) refers to the combination of antiplatelet therapy consisting of aspirin plus a P2Y receptor inhibitor (clopidogrel, prasugrel or ticagrelor).
- The scope of this update is limited to addressing recommendations in what situations (evaluating risk-benefit ratio, risk of clotting to the risk of bleeding) to use DAPT and duration of DAPT in patients with CAD.
- Several studies were reviewed in patients with coronary stent implantation assessing shorter duration or longer duration of DAPT and a large randomized clinical trial (RCT) of patients greater than one year post MI assessing the efficacy of DAPT compared to aspirin therapy alone.
- In accordance with IOM recommendations for the development of Trustworthy Guidelines, PICOT critical questions were addressed related to the duration of DAPT. A separate Evidence Review Committee (ERC) evaluated the evidence pertaining to the critical questions.
- This guideline includes information for the dosing of aspirin in patients treated with DAPT.
- This Guideline also includes information on the use of triple therapy (aspirin, P2Y Inhibitor, and oral anticoagulants) and includes a summary and synthesis of the Guidelines, Expert Consensus Documents and comprehensive review article recommendations on the Management of patients treated with triple therapy.
- Several overriding concepts and updated recommendations for DAPT and duration are summarized in this guideline.
- This focused update of six Guidelines provides the most up to date recommendations on the use of DAPT and its duration of use in patients with several different coronary artery disease states. These recommendations are made with the intention to assist clinicians in the use of DAPT using the most contemporary evidence for the prevention of new and recurrent disease.
Citation
Levine GN, et al. 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: an update of the 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention, 2011 ACCF/AHA guideline for coronary artery bypass graft surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease, 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction, 2014 ACC/AHA guideline for the management of patients with non–ST-elevation acute coronary syndromes, and 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery [published online ahead of print March 29, 2016]. Circulation. doi: 10.1161/CIR.0000000000000404.
Bittl JA, et al. Duration of dual antiplatelet therapy: a systematic review for the 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published online ahead of print March 29, 2016]. Circulation. doi: 10.1161/CIR.0000000000000405